HomeMy WebLinkAboutFull Septic Repair - Installation Certification - As-Built Plan / Installation Certificate Form - 35 HOLLOW TREE LANE 5/11/2022 ,s�,.rrtan,rs
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PUBLIC HEALTH DEPARTMENT
Community&Economic Development
TOWN OF NORTH ANDOVER
SEPTIC DISPOSAL SYSTEM—INSTALLATION CERTIFICATION
The undersigned hereby certify that the Sewage Disposal System( )constructed; (x)repaired;
By. Thorsen Akerley
(Print Name)
Located at: 35 Hollow Tree Lane
(Installation Address)
Was installed in conformance with the North Andover Board of Health approved plan,originally dated
12/2/2021 and last revised on 1/24/22 ,with a design flow of
440 _gallons per day. The materials used were in conformance with those specified on the
approved plan;the system was installed in accordance with the provisions of 310. CMR 15.000,Title 5 and local
regulations,and the final grading agrees substantially with the approved plan.All work is accurately represented on
the As-built which has been submitted to the Board of Health.
Bottom of Bed Inspection Date: 4/15/22
Engineer Representative( ignature)
Thorsen Akerley
And—Print Name
Final Construction Inspection Date: 4/20/222d�+L.rQ
Engineer Representative( ignature)
Thorsen Akerley
And—Print Name
Installer: (Signature) Date: TTU
And—Print Name
Engineer: /Z&1ZQ. Z,,cQA42.�¢y (Signature) Date: 5/9/2022
Thorsen Akerley
And—Print Name
120 Main Street, North Andover, Massachusetts 01845
Phone 978.688.9540 Fax 978.688.9542 Web http://www.northandoverma.gov